Isifo somoya (Brashchial asthma kanye nesifo sikashukela) kuphambene nesizinda sokungasebenzi kahle kwamasosha omzimba. Isifo sikashukela sikhula njengesifo se-autoimmune ngokukhiqizwa kwama-antibodies kumaseli we-pancreatic uqobo. E-asthma ye-bronchial, impova yezitshalo, ukudla, izinwele zezilwane namagciwane enza njenge-antigen.
Ekuhlolweni kobudlelwano obuphakathi kwalezi zifo, kwatholakala ukuthi imvelo ithinta ukuthuthukiswa kwezinhlobo zombili zesifo sikashukela kanye nesifuba somoya (i-asthma) esihlasela izivikeli mzimba. Ingozi yesifuba somoya kuma-diabetesics iphezulu kunabantu abangenazo izifo ze-autoimmune.
Kukhona nengozi yokulimazeka kwe-carbohydrate metabolism ye-asthmatics esebenzisa ama-glucocorticosteroids ekwelashweni. Ngale nhlanganisela, ukuthuthukiswa kwesifo sikashukela, njengezinkinga zesifo se-steroid, kuvame kakhulu kune-osteoporosis noma eminye imiphumela emibi, kepha wonke ama-steroid kanye nezivuseleli ze-beta-receptor ziba zimbi kakhulu izifundo zesifo sikashukela esikhona.
Izimbangela zokuthuthuka nezimpawu zesifo sikashukela
Enye yezimbangela zesifo sikashukela, ikakhulukazi uhlobo lokuqala, yisiphetho sofuzo, ukuba khona kwesifo sikashukela kubazali kukhulisa ubungozi bokukhulisa ingane ngamaphesenti angaphezu kwama-40.
Ngohlobo lwe-1 yesifo sikashukela mellitus, kukhona ukuxhumana ngezifo ezedlule ezithathelwanayo noma ze-autoimmune. Isifo sikashukela kungaba inkinga yezinkinga zesifo somdlavuza womdlavuza noma inqubo yokuvuvukala.
Ukuxineka kwengqondo, kanye nezifo zohlelo lwe-endocrine - indlala yegilo, indlala ye-adrenal noma i-pituitary gland, kuholela ekungalingani kwe-hormonal emzimbeni futhi kukhuphule okuqukethwe ama-hormone aphikisayo egazini.
Uhlobo 2 i-mellitus yesifo sikashukela esingancikeli i-insulin livame ukukhula ngalezi zizathu ezilandelayo:
- Kubantu ngemuva kweminyaka engama-45
- Ngokukhuluphala ngokweqile, ikakhulukazi uhlobo lwesisu sokukhuluphala.
- I-Atherossteosis, i-cholesterol ephezulu ne-dyslipidemia.
- Umfutho wegazi ophezulu we-Arterial.
- Ukuphuza imithi - ama-hormone, ama-beta-blockers, ama-thiazide diuretics.
Ngokutholwa kwehlobo lwe-1 mellitus yesifo sikashukela, kuthathwa izimpawu ezijwayelekile: ubuthakathaka obukhuphukile, ukwanda kokuchama, ukukhipha umchamo wobusuku ebusuku, ukunciphisa umzimba. Ukwanda kwesifiso sokuchama kuyaphawulwa. Iziguli zizizwa zomile njalo nomlomo owomile, ongahambi ngemuva kokuphuza uketshezi.
Ukwesaba okungaguquki, ukuguquguquka kwemizwelo, kanye nokucasuka, kanye nokukhathala nokudangala ku-mellitus yesifo sikashukela, kubonisa ukushoda kwe-glucose kumaseli wobuchopho, njengesitho esizwela kakhulu ukungondleki.
Izinga elikhuphuka njalo likashukela egazini libangela ukulunywa kwesikhumba nokucasuka kolwelwesi lwama-mucous, kufaka phakathi i-perineum. Ukungezwa kwezifo zokukhunta ngendlela ye-candidiasis kuthuthukisa lolu phawu.
Ngaphezu kwalokho, iziguli ezinesifo sikashukela zikhononda ngokuxineka noma ukulunywa kwezinyawo nezandla, ukuqubuka kwesikhumba, i-furunculosis, izinhlungu zenhliziyo nokuguquguquka komfutho wegazi.
Uma izimpawu zinokuvela ngezikhathi ezithile futhi ziphela, khona-ke ukuxilongwa kungenzeka ngemuva kwesikhathi - ngesikhathi sokukhula kwezinkinga (ketoacidosis).
Ezigulini ezinoshukela omningi wegazi, isicanucanu, ukuhlanza kanye nobuhlungu besisu kukhuphuka, iphunga le-acetone libonakala emoyeni ophelile, ngesifo esinamandla se-ketoacidosis, ukwazi ukuthi kugcwele amandla, isiguli siwele ekhefini, sihambisane nokuqunjelwa kanye nokuphelelwa ngamandla komzimba.
Ukuqinisekisa ukutholakala kwesifo sikashukela, kwenziwa ukuhlola okusheshayo kwegazi - ngesifo sikashukela, ushukela kuphezulu kune-6.1 mmol / l, lapho usebenzisa isivivinyo sokukhuthazelela ushukela ngemuva kwamahora 2 ngemuva kokuzivocavoca, kungaphezu kuka-7.8 mmol / l. Ngaphezu kwalokhu, ama-antibodies athize, i-glycated hemoglobin, ayahlolwa.
Izimo nezimpawu zesifo somoya (asthma) se-bronchial
I-asthma ye-bronchial yenzeka nge-spasm yendlela yokuphefumula ngaphansi kwethonya lezinye izincazelo ezithile. Inesici sofuzo ekukhuleni ngendlela eyindlalifa yofuzo ekuphenduleni komzimba.
Kungacasulwa ukubhema, ukukhulisa ukuzwela kwe-bronchi ukungcoliswa komoya ngothuli, amagesi aqothulayo, kanye nokukhishwa kwemfucuza yezimboni. Isifuba somoya sivame ukwenzeka ngemuva kokutheleleka ngegciwane noma ngegciwane, i-hypothermia, ukuzikhandla okukhulu ngokomzimba, nokulimala kwesifuba.
Isibonakaliso esijwayelekile somoya wesifuba somoya ukukhwehlela okunezifo ezihlasela ukuhlaselwa yisifuba somoya, ukufuphala, ukushaya ikhwela nokuphefumula kwe-bronchi.
Nge-asthma ye-bronchial, izimpawu ezibalulekile zokuxilonga yilezi:
- Ukuqagela komndeni (isifuba somoya, i-atopic dermatitis, i-hay fever, i-rhinitis).
- Ukuvela komzimba ngemuva kokuxhumana nezitshalo noma izilwane, ngezifo zokuphefumula.
- Ukuhlaselwa kokhwehlela kanye nesifuba somoya kuyaqina ebusuku, ngemuva kokuzivocavoca umzimba, ukuguquka kwesimo sezulu.
I-asthma ye-bronchial sikashukela ivela kaningi ngohlobo lokuqala, oluncike ku-insulin. Kwakungekho ukuhlangana phakathi kwesifo sikashukela sohlobo 2 kanye nesifo somoya.
I-Steroid-Resistant Asthma nesifo sikashukela
Ezigulini ezine-asthma ezinesifo sikashukela se-steroid, inkambo ye-asthma imvama kakhulu, okuyisizathu sokuqokwa kwama-steroid e-systemic. Ukusetshenziswa kwazo kumithamo ephezulu noma isikhathi eside kuholela ekukhulupheni. Ukwehla komzimba ngokweqile kungadala i-apnea ebusuku noma ubunzima bokukhwehlela. Ukukhuluphala futhi kukhulisa ukubonakaliswa kwesifo sikashukela.
Ezigulini eziningi ezine-asthma ye-bronchial, ziyakwazi ukudambisa ukubanjwa ngamandla kwe-glucocorticosteroids esekwe ngaphakathi. Kwezinye iziguli, lokhu akuniki umphumela ofiseleka ngendlela yokwanda kwe-bronchi, noma ngabe usebenzisa ama-steroid ngaphakathi noma ngendlela yemijovo.
Iziguli ezinje zithathwa njengemelana ne-steroid. Ukuphikiswa kweSteroid kubhekwa kufakazelwa uma ivolumu yokuphoqelela ephoqelelwe ku-1 s (njengoba ilinganiswa ne-spirometry) - I-FEV 1 ayikhuphuki ngaphezulu kwe-15% ngokuphefumula kwe-betamimetic ngemuva kokuthatha i-40 mg ye-prednisolone ngosuku ngeviki.
Ekutholakalweni kwe-asthma emelana ne-steroid, lezi zivivinyo ezilandelayo ziyadingeka:
- Ukutadisha umsebenzi wamaphaphu nenkomba yeTiffno.
- Setha inkomba yokwandiswa kwe-bronchial ngemuva kwe-200 mcg ye-salbutamol.
- Yenza ukuhlolwa kwe-histamine.
- Nge-bronchoscopy, hlola izinga lama-eosinophils, i-cytology ne-biopsy ye-bronchi.
- Ngemuva kwamaviki ama-2 uthathe i-Prednisolone, phinda uvivinyo lokuxilonga.
Lokhu kuhluka kwenkambo yesifo somoya esaziwa ngokuthi i-asthma kubonakaliswa ukuhlaselwa okuvama futhi okunzima okudinga ukulaliswa esibhedlela, kufaka phakathi ezikhungweni zokunakekelwa kakhulu, ukwehla kwezinga lempilo.
Ngakho-ke, ngaphezu kokuphefumula kwama-steroid, iziguli ezinjalo zibuye zisetshenziswe ngomlomo noma ngomjovo. Ukwelashwa okunjalo kuholela ku-Itenko-Cushing's syndrome kanye nesifo sikashukela se-steroid. Kaningi, abesifazane abaneminyaka engu-18 kuya kwengama-30 bayagula.
Izici zokwelapha i-asthma kushukela
Inkinga enkulu yokwelapha i-asthma ye-bronchial in sikashukela ukusetshenziswa kwezidakamizwa eziphefumulile, ngoba izakhi ze-beta-receptor ku-bronchi kanye ne-systemic corticosteroids zandisa ushukela wegazi.
I-Glucocorticosteroids ikhulisa ukuqhekeka kwe-glycogen kanye nokwakhiwa kwe-glucose esibindini, i-betamimetics yehlisa ukuzwela ku-insulin. ISalbutamol, ngaphezu kokukhuphuka kweglucose yegazi, yandisa ingozi yezinkinga ezinjenge-ketoacidosis yesifo sikashukela. Ukwelashwa kwe-Terbutaline kuphakamisa amazinga kashukela ngokuvuselela ukukhiqizwa kwe-glucagon, okuyi-insulin antagonist.
Iziguli ezithatha izisusa ze-beta njengama-inhalation mancane amathuba okuba zihlushwa yi-hypoglycemia kunaleyo esebenzisa imishanguzo ye-steroid. Kulula ngabo ukuthi balondoloze uzinzo kashukela wegazi ozinzile.
Ukwelashwa nokuvinjwa kwezinkinga zesifuba somoya nesifo sikashukela kususelwa kule migomo elandelayo:
- Ukuqashelwa yi-endocrinologist kanye ne-pulmonologist, i-allergist.
- Ukudla okufanele nokuvimbela ukukhuluphala.
- Ukugcina ukusebenza komzimba.
- Ukulawulwa okuqinile kweshukela egazini lapho usebenzisa ama-steroid.
Ezigulini ezine-asthma ye-bronchial, ukunqamuka ngokuphelele kokubhema kuyadingeka, ngoba lesi sici siholela ekuhlaselweni njalo kwe-suffocation futhi sibangela ukwephulwa kokujikeleza kwegazi, i-vasospasm. Esikhathini sikashukela i-mellitus, ezimweni ze-angiopathy, ukubhema kukhulisa ubungozi bokuthola i-neuropathy yesifo sikashukela, isifo senhliziyo, ukubhujiswa kwe-glomeruli yezinso nokwehluleka kwezinso.
Ukuqokwa kwama-glucocorticosteroids kumathebulethi ngenkambo ehlanganyelwe yesifo sikashukela kanye nesifo somoya (bronchial asthma), kumele kube nezimpawu eziqinile. Lokhu kufaka phakathi ukuhlaselwa kwe-asthma okuhlala njalo nokungalawulwa, ukuntuleka komphumela kusukela ekusebenziseni kwama-steroid inhalations.
Ezigulini esezinqunyelwe ukulungiswa kwe-glucocorticoid kumathebulethi noma ezidinga umthamo omkhulu wama-hormone, i-Prednisolone ikhonjiswa isikhathi esingadluli izinsuku eziyishumi. Ukubalwa komthamo kwenziwa ngekhilogremu yesisindo somzimba ngosuku, kungabi ngaphezu kwe-1-2 mg ngekhilogremu.
Isizathu esivame kakhulu sokwakhiwa kwesifo sikashukela se-steroid kanye nezinkinga zesifo esikhona ukuqokwa kwezidakamizwa ze-steroid ezingadala idepho emzimbeni. Le mithi icindezela ukusebenza kwezindlala ze-adrenal; azinakunqunywa esikhathini esifushane. Izidakamizwa ezinje zifaka phakathi: i-Dexamethasone, Polcortolone neKenalog.
Izinzuzo zokusebenzisa i-asthma nesifo sikashukela yilezi:
- Umuthi ophephe kakhulu ophehlwe onama-steroid yiBudesonide. Ingasetshenziswa ezinganeni nakubantu abadala, futhi inqunyelwe abesifazane abakhulelwe.
- I-Pulmicort ngesimo se-nebul ingasetjenziswa kusuka kumuntu 1 ubudala, isetshenziselwe isikhathi eside, ekuvumela ukuthi wenqabe amaphilisi wePrednisolone. I-powder eyomile ku-turbuhaler inqunywe kusuka eminyakeni engu-6.
- Ukwelashwa nge-fluticasone propionate ku-nebulas kungathatha uhlobo lwe-monotherapy futhi akudingi ukunikezwa okwengeziwe kwemithi ye-systemic.
Lapho ufunda ngethonya lemisebe ye-ultraviolet ekuvinjelweni kokukhula kwezifo ngempendulo yokuzivikela komzimba, kwatholakala ukuthi ukwakheka kukavithamini D esikhunjeni kunciphisa ingozi yesifo sikashukela. Ngakho-ke, izingane ezingaphansi konyaka owodwa ubudala ezithatha i-Vitamin A ukuvimbela ama-rickets mancane amathuba okuthi zitholakale nesifo sikashukela.
I-Vitamin D ikhonjiswa kuzo zonke iziguli ezithatha i-prednisolone ukuvimbela i-osteoporosis, okuvame ukuba ngumphumela omubi wama-steroid.
Ukuze uvikele izinkinga zesifo sikashukela ekwelapheni i-asthma ye-bronchial, iziguli ziyalulekwa ukuthi zilandele indlela yokudla enomkhawulo wama-carbohydrate alula nokudla okungadala ukungahambi kahle komzimba.
Ukuqapha njalo kwezinga le-carbohydrate metabolism kanye nokulungiswa kwamthamo ngenkathi kunqunywa ama-glucocorticoids kuyadingeka. Kungcono ukusebenzisa indlela ye-inhalation yokuphatha, futhi uma kunesidingo, phatha ukwelashwa nge-prenisolone ngezifundo ezimfushane. Ukwandisa izinga lomsebenzi womzimba, ukuvivinya umzimba ngokuzivocavoca nokuzivocavoca ngokuphefumula kukashukela kuyanconywa. Ividiyo ekulesi sihloko izachaza ukuthi kungani i-asthma iyingozi kakhulu kushukela.
